Drop-off form | Nashville Cat Clinic

DROP OFF APPOINTMENTS/SURGERIES

Easily submit your drop-off appointment or surgery details for your cats scheduled drop off/surgery appointment. Complete the form below to ensure we have all the necessary information before your visit.

Date

Your name

Cat's name

Did your pet receive Gabapentin this morning?

If so, what dose and time?

Current medications: (please list name, strength of medication, how often it is being administered)

Were the medications listed above administered this morning?

If so, what time?

Reason for drop off appointment today:

If your cat is ill (vomiting, diarrhea, etc.), how long have the symptoms been going on?

If your pet is here for a surgery or any type of sedation, please sign here:

Sedative/Anesthesia Release: You are to use all reasonable precautions against

injury, escape, or death of my cat. I understand all anesthesia involves some

minimal risk to my cat, but you will not be held responsible in any manner what-

soever or under any circumstances in connection therewith, as it is thoroughly

understood that I assume all risks. By typing your name in the field provided, you acknowledge that this action constitutes your legally binding electronic signature.

If your pet is here for a dental procedure, please acknowledge that, if extractions are necessary, we are permitted to extract teeth even if we are not able to reach you via phone.

If you did not bring food for your pet today for post-op recovery, would you like us to feed him/her post op? (Please note if on a prescription diet, additional fees will apply)

If your cat is on a special diet please explain

Is your cat allergic to anything that we need to know about? (Ex. Chicken, fish, etc.)

(If yes, please list the allergy below)